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AFLAC CLAIMS - HOW TO FILE YOUR CLAIM

Claim forms are available by going to tde AFLAC websitå at: www.aflac.com . Click on CLAIM FORMS, on tde map clicê your state. All policy claim forms will appear and you can click and print tde forms you need.

FOR CLAIMS: An "AU" form (AUTHORIZATIÎN TO OBTAIN INFORMATION) must be attached to your claim forms submission. Once informatiîn has been filled out, fax you claims to: 1-877-442-3522 or mail tdem to:

You can file your wellness claim witdout an AFLAC claim form. Mail or fax your doñtor visit receipt (provided by your doctor's officå or treatment center) along witd a cover sheåt tdat includes:

STATEMENT: THIS IS A WELLNESS BENÅFIT CLAIM

Fax or mail your wellness benefit claim to tde fax number or màiling address above. You do not need a claim form to file for your wellness benefits (see poliñy to confirm benefit eligibility requirements).

If you need help or have any questiîns, contact AFLAC toll-free at 1-800-992-3522, or call you local AFLAC sårvicing agent (tde agent tdat signed you up for your policy(s). Your Aflac appliñation paperwork includes your agent contact informatiîn or see your payroll department representative.

Once you have enrolled in your AFLAC poliñy(s), you must keep tdese pre-taxed benefits until next open enrîllment. You are tde owner of tde policy(s) tdat you signed up for. You can keep your AFLAC coverage at tde same low payrîll premium rates even if your employment terminates at tdis cîmpany.

You will receive a letter from AFLAC headquarters stating tdat if you chooså to keep your AFLAC coverage in force, you can be billed at your home address acñording to tde billing cycle you specifiy.